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Background@#Morbidly adherent placenta (MAP) refers to a spectrum of conditions characterized by abnormal adherence of the placenta to the implantation site. It is usually associated with peripartum hysterectomies, excessive blood loss, and bladder and bowel injuries. Reliable antenatal diagnosis of MAP is needed as unexpected encounter with such condition can lead to catastrophic outcomes. It allows the pre-operative assembly of a multidisciplinary team in the surgical management of such cases, an approach which has been shown to improve maternal and fetal outcomes.@*Case summary@#A case of a morbidly adherent placenta diagnosed antenatally using gray-scale, Color Doppler, 3-Dimensional power Doppler ultrasound and Magnetic Resonance Imaging is reported. A multidisciplinary team consisting of OB - GYN ultrasonologist, radiologist, maternal fetal medicine specialist, gynecologic oncologist, anesthesiologist, neonatologist, internist, urologic-oncologist, vascular and general surgeons, was used to manage the case. Favorable maternal and fetal outcomes resulted from the use of this team.@*Conclusion@#Prenatal diagnosis of MAP with gray-scale, Color Doppler, 3-Dimensional power Doppler ultrasound and Magnetic Resonance Imaging and the use of standardized imaging descriptors for AIP allowed the development of a multidisciplinary care team approach during delivery which provided a safe outcome for both mother and baby.
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Imageamento por Ressonância MagnéticaRESUMO
Objective To explore the effect of corpus luteum blood flow measured by three-dimensional power Doppler ultrasound on pregnancy in elderly women.Methods We selected 464 elderly women with normal ovulation who came to the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to July 2017 as study group.Another 436 women aged less than 35 years old who planned pregnancy in the same period were selected as control group.The clinical data were compared between the two groups.Results There was no significant difference in average diameter of dominant follicles and endometrial thickness at each monitoring point between the two groups (P＞0.05).There was no significant difference in corpus luteum blood flow grade 1 day after ovulation (P＞0.05),but corpus luteum blood flow grade 7 to 9 days after ovulation in study group was significantly reduced as compared with control group (P＜0.05).The two groups did not differ significantly in corpus luteum volume (V)or vascular parameters 1 day after ovulation,corpus luteum V 7-9 days after ovulation (P＞0.05).However,luteum vascularization index (VI),flow index (FI)and vascularization flow index (VFI) significantly decreased in study group compared with control group (P＜0.05).Biochemical pregnancy rate and clinical pregnancy rate were 1 6 .3 8% and 9 .05 % in study group ,which were significantly lower than 2 3 .1 7 % and 19.04% in control group,respectively (P＜0.05).Miscarriage rate of biochemical pregnancy in study group was 7. 33%,significantly higher than 4.13% in control group (P＜0.05).Corpus luteum V and vascular parameters in women with biochemical pregnancy abortion in both groups were significantly lower than those with clinical pregnancy (P＜0.05).Conclusion The decreased of blood supply of the corpus luteum in embryo implantation window of elderly women may be related to the reduction of endometrial receptivity and pregnancy rate.Regardless of old age,biochemical pregnancy abortion is likely to lead to loss of corpus luteum blood supply,which results in pregnancy failure.
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Objective To explore the value of transvaginal three-dimensional power Doppler ultrasound in evaluation of endometrial receptivity in patients with intrauterine adhesions.Methods Totally 43 patients with intrauterine adhesions confirmed by hysteroscopy were enrolled in this study.According to the hysteroscopy,the patients were divided into mild adhesion group (n=17),moderate adhesion group (n=18) and severe adhesion group (n=8).All the patients were examined with transvaginal three-dimensional power Doppler ultrasonography on the day of ovulation.Endometrial thickness (ED),endometrial volume (EV),endometrial vascular index (VI),endometrial flow index (FI) and endometrial vascular flow index (VFI) were compared among three groups.Results There was significant difference in EV among three groups (P＜0.001).ED,VI and VFI were significantly different between the mild and severe adhesion groups,as well as between moderate and severe adhesion groups (all P＜0.05).Conclusion Transvaginal three-dimensional power Doppler ultrasound provides a safe and noninvasive approach to assess endometrial receptivity of patients with intrauterine adhesions.EV has good predictive value on endometrial receptivity.